HGMT

Inpatient care consists of
Health care delivered in conjunction with an overnight stay in a facility
Hospitals must have atleast how many beds?
six
Biggest share of national health spending is used by?
Hospitals
Define “excess capacity” in health care inpatient sector
Empty beds
What is the effect of intense consolidation in certain hospital markets?
Dilution of competition
List 3 requirements to be a hospital
At least 6 beds, must be licensed, have an organized physician staff, and food services meet nutritional needs.
List 3 factors that contribute to the growth of hospitals
Advances in medical science, advances in medical education, development of specialized technology/surgical services, and development of professional nursing.
The Hill-Burton Act was passed in order to…?
Relieve shortage of hospitals
The swing bed program allowed rural hospitals to…?
Use the same beds for acute care or long-term care
How did the PPs based on DRGs lead to hospitals downsizing in the U.S.?
It created financial incentives to minimize the patient’s length of stay
Define Occupancy Rate
The proportion of a hospital’s capacity that is actually utilized
What hospitals are NOT LIKELY to serve the general public?
Federal Hospitals
For whose financial benefit are proprietary hospitals operated?
Stockholders
What hospitals provide services to children in communities that do not have specialty children’s hospitals?
General Hospitals
To be classified as a Critical Access Hospital, the number of acute care beds should not exceed…?
25 beds
According to US law, what type of organizations are tax exempt?
Nonprofit Organization
What entity oversees the licensure of health care facilities?
State Government
Emergency departments, in most cases are equipped to provide…?
Secondary and Tertiary care services
List the 3 classes of hospitals by ownership
for-profit (proprietary), non-profit, and federal
What are typical settings for ambulatory care services?
Sports medicine clinics, physicians’ offices, and dialysis centers
Tertiary care is…
Highly specialized!
What is the most prominent reason for the decline in the number of procedures performed in hospitals?
Most of these procedures were shifted to outpatient setting
Growth in outpatient serves are affected by…?
Managed care, new technology, and patient preference
Hospice services are primarily for people with…?
Terminal illnesses
Define Palliation
Pain and Symptom management
Community health centers primarily serve what type of population?
Populations which are medically underserved
Under capitation, risk is shifted from the…. to the….?
from the MCO to the PROVIDER
The HMO Act of 1973 required…?
Employers to offer an HMO alternative to conventional health insurance
List 3 cost control methods used by MCOs
Choice restriction, Case management, Disease management, and Pharmaceutical management.
Under the fee-for-service system, providers had the incentive to…?
Deliver more services than what would be medically necessary because a greater volume would increase their incomes
In a closed-panel plan…
the enrollee is restricted to the providers on the panel
Define Case Management
Cost-effective management of care for patients who have complex medical conditions
Concurrent UR in a hospital will be primarily concerned with the…?
length of stay
Closely associated with concurrent UR is the function of…?
Discharge planning
Review of patterns of practice is undertaken as part of…?
Retrospective Utilization Review
Define Practice Profilling
Monitoring of provider-specific practice patterns
What HMO model is likely to provide the greatest control over the practice patterns of physicians?
The Staff Model
Who employs the physicians in the group practice model?
The group practice
Who contracts with more than one group practices?
A Network Model HMO
A hybrid between an HMO and PPO is…?
Point-of-service plans
What type of MCO has achieved the greatest success in member enrollment?
PPOs
How are employers coping with the rising cost of health insurance premiums?
They are shifting costs to the employees
What is not an example of consolidation?
Building of new facilities
What are examples of consolidation?
Acquiring an existing facility, Merging with an existing organization, and Alliances among existing organizations
Define Acquisition
When an organization ceases to exist as a separate entity and is absorbed into the purchasing corporation
Define Merger
Two organizations cease to exist, and a new corporation is formed
Define Joint Venture
A new corporation created by two partnering organizations remains independent
What type of integration is represented by a chain of nursing homes?
Horizontal Integration
Antitrust legislation is intended to provide checks against
Anticompetitive Behavior
List the 3 type of MCOs
HMOs, PPOs, and POSs
List 3 types of utilization review
Prospective, Concurrent(discharge), and Retrospective
What entity oversees the licensure of health care facilities?
The State Government
What entity in hospital governance is legally responsible for the hospital’s operations?
The Board of Trustees
What type of hospital may emphasize the sponsoring organization’s spiritual and dietary principles?
Church-affiliated hospitals
In a hospital classified as short stay, the ALOS is not more than…?
25 days
What ownership type constitutes for the largest group of hospitals and hospital beds in the U.S.?
Private nonprofit
One reason women’s health centers were created is…?
Women seek care more often than men
What organization was specifically created to bring management expertise to physician group practices?
Management services organizations
How does risk adjustment affect payments to managed care plans?
Risk adjustment takes into account the enrollees’ health status
Prospective utilization review includes…?
Precertification
In what model are physicians employees of the HMO?
The Staff Model
What is the purpose of risk sharing with providers?
It makes providers cost conscious
Define Discounted Fees
a modified form of fee for service
“Self-care with professional support” is an example of?
Disease Management
“An experienced health care professional, such as a nurse practitioner, coordinates an individual’s total health care” is an example of?
Case Management
List 3 types of utilization review